Wk 4 Depression & Anxiety Pathophysiology Flashcards
Neurotransmitters are responsible for
communication between neurons and other cells
Neurotransmitters travel across the synapse and either
Block or facilitate relay of stimulus
4 major neurotransmitters
Dopamine, norepinephrine, serotonin, GABA
Dopamine associated with…
Happiness, motivation, pleasure, reward, focus, energy, learning, anti anxiety
Serotonin associated with…
Obsessions and compulsions, happiness, sleep
GABA associated with…
Relaxation
Norepinephrine associated with…
Alertness and energy
Low levels of dopamine results in
Parkinson like symptoms such as… slower reaction time, low energy, anhedonia
Anhedonia is
Inability to experience pleasure in things you usually enjoy “pleasure center dysfunction”
Serotonin deficit results in
more obsessive thoughts and compulsions, impulsivity, suicidal, aggressive, susceptible to “cue triggers” / lack of impulse control
Deficits in GABA is associated with
Anxiety disorders, panic disorders, major depressive disorder
Excitatory neurotransmitter associated with fight or flight response
Norepinephrine
High levels of norepinephrine results in
Heightened anxiety, stress, and hyperactivity
Low levels of norepinephrine is associated with
Lack of energy, focus, and motivation
Women are twice as likely to suffer from
Depression
Depression is more common in those who are
Caucasian and have never been married
Those with depression are __% more likely to develop CAD
64%
Leading cause of disability worldwide
Depression
Depression a combination of…
Genetic, environmental, biological and psychological factors
Depression dx depends on the presence of multiple symptoms that are…
Intense enough to cause distress and persistently impair psychosocial function
Multiple etiologies associated with depression including:
Neurobiological, chemical, situational, chronic and acute, medication side effects
Symptoms of depression
Loss of interest or pleasure, extreme fatigue, restlessness, irritability, sleep disturbances, appetite disturbances, impaired concentration
Treatment of depression includes
medications, CBT and talk therapy, support groups
All depression medications take…
weeks to start working
For depression that does not respond to medications and therapy we may use
brain stimulation therapy
6 major types of anxiety disorders
Social, panic, acrophobia, PTSD, generalized, OCD
Unlike depressive disorders
Anxiety disorders have different symptoms and are treated differently
Panic disorder characterized by 2 main symptoms
Antianticipatory anxiety and avoidance anxiety
Anticipatory anxiety is
Fearful expectation of panic anxiety onset
Avoidance anxiety is
Personal strategies used to increase sense of control and decrease the risk of panic anxiety
What is linked to adult panic disorder?
Early childhood stress
Panic disorder is likely to
run in families
Overwhelming stress can stimulate and cause a buildup of
Glutamate
What is panic?
Unexpected episode that is out of proportion to events that are happening around the patient
Half of patients with panic disorder also have…
Depression
Recurrent uncomfortable episodes with sudden onset with symptoms
Panic attack
Symptoms associated with panic attack
Heart palpitations, chest pain, SOB, dizziness, nausea, fear of losing control, tingling in hands, flushing or chills
Treatment of panic disorders includes…
CBT, antidepressants
Panic disorder is treated with these types of antidepressants
SSRIs, SNRI, TCA, MOA inhibitors
Second line medication to treat panic attacks
Benzodiazepine, used to treat attack in the moment
Anxiety that lasts for more than 6 months, characterized by unrealistic, uncontrolled anxiety
Generalized anxiety disorder
Generalized anxiety disorder is characterized by…
Muscle tension, autonomic hyperactivity, exaggerated startle, difficulty concentrating
Risk factors for generalized anxiety disorder
Substance abuse, childhood abuse/trauma, and genetic components
Treatment for generalized anxiety disorder
Antidepressants SSRI and SRNI, Buspirone, benzodiazepine
3 core symptoms of hyper-arousal, avoidance, reliving of events
PTSD
In PTSD, there is chronic activation of the
Stress response in relation to exposure to a potentially life threatening event
PTSD is characterized by…
Vivid flashbacks, nightmares, emotional blunting, irritability and exaggerated startle
Common along with PTSD
Memory, sleep, and depression problems
Number one cause of PTSD
For both men and women it’s rape
Other common causes of PTSD for men
Combat exposure, childhood neglect, childhood physical abuse
Other common causes of PTSD for women
Sexual molestation, physical attack, being threatened with a weapon
Psychotherapy treatment for PTSD
Trauma focused, exposure therapy, CBT, EMDR, medications (SSRIs SNRIs)
Eye movement desensitization and reprocessing (EMDR) works well along with CBT to
Treat PTSD
Intense fear of being criticized by others, persistent fear of humiliation, and negative evaluation of embarrassment in social situation
Social anxiety disorder
Social anxiety disorder causes…
withdrawal from social situation or intense discomfort
Causes of social anxiety disorder
Inherited traits, environment (learned behavior), or brain structure- amygdala
Treatment of social anxiety disorder includes…
CBT, SSRIs, Benzos, propanolol
Repetitive unwanted thoughts and obsessions, repeated activities/rituals
OCD
Obsessions and compulsions are..
Time consuming, and may be distressing to individual, friends, or family members
Most difficult psychiatric conditions to treat
OCD
Treatment of OCD
SSRIs, TCA (second line), deep brain stimulation, EMDR, transcranial magnetic stimulation (approved in 2018)
